Acute Kidney Injury Clinical Trial
Official title:
Biomarker-guided Implementation of Glutamine to Reduce the Occurence of AKI After Cardiac Surgery
The aim of this study is to evaluate whether the application of glutamine versus control in patients with high risk for AKI identified by biomarkers can reduce kidney damage after cardiac surgery.
Cardiac surgery is characterized by an increased production of free radicals as a consequence
of surgical trauma, ischemia-reperfusion injury, inflammatory response syndrome in response
to the use of the extracorporeal circulation. This results in an increased production and
release of free radicals which may lead to an exhaustion of antioxidants and organ failure
since the lungs, kidneys, liver and gastrointestinal tract are particularly susceptible to
reactive oxidant species. Glutamine is considered as a conditionally indispensable amino acid
in catabolic states of critically ill patients. It belongs, together with other mediators, to
the host defense as major intracellular direct free radical scavengers. Its depletion has
been demonstrated to be an independent predictor of mortality in a group of ICU (intensive
care unit) patients. Clinical studies showed a positive outcome effect. In animal models,
glutamine reduces the occurrence of AKI after ischemia-reperfusion injury. This could be
demonstrated through reduced functional markers as well as reduced renal biomarker levels.
Preliminary data suggest that glutamine has pleiotropic effects since it has effects on the
immune system (reduced expression of cytokines) as well as on tubular epithelial cells
(unpublished animal data from our laboratory).
Thus, a randomized-controlled trial to analyze the effects of glutamine supplementation in
high risk patients identified by renal biomarkers undergoing cardiac surgery with
cardiopulmonary bypass (CPB) on the effects of kidney damage is urgently needed.
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